malformatii cardiace congenitale_1

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    MALADII CONGENITALE

    CARDIACE

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    DATE EPIDEMIOLOGICE

    5-20 de cazuri la 1.000 nn vii

    Cele mai frecvente anomalii la om

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    ETIOLOGIE

    Factori genetici Aberaii cromozomiale

    Multifactorial TORCH Factori de mediu

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    EMBRIOLOGIE

    Tubul cardiac prima lun (nn 10 mm)

    Rotaie, segmentare, torsiune d-loopventral i la dreapta

    Cordul n luna a doua Diviziune sinoatrial

    - conotroncus

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    CIRCULAIA FETAL

    Rezistena vascular pulmonar mare Foramen ovale

    Canalul arterial Canalul Arantius

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    DIAGNOSTIC POZITIV

    Anamneza Examen clinic

    Investigaii paraclinice

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    ANAMNEZA

    Afeciuni materne Evaluare retardul creterii

    - edeme- intoleran la efort- stridor- disfagie pentru solide

    - sincopa

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    EXAMEN CLINIC

    Sindrom dismorfic malformaii asociate Tegumente Timp de recolorare capilar Degete hipocratice Edeme Puls Auscultaie Tensiunea arterial

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    SINDROAME

    Holt-Oram (Heart-Hand syndrome, is an inherited disorder characterizedby abnormalities of the upper limbs and heart(DSA,DSV) )

    Turner (95% of individuals with Turner syndrome have both short stature andsigns of ovarian failure (no breast development by age 12 years or not started

    menses)upon physical examination) Down (facies mongoloid,microgntie, hipotonie,o singura linie

    palmara,macroglosie, gat scurt,pete albe pe iris,laxitate articulara accentuata, malfcardiace)

    Marfan (arahnodactilie)

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    INSPECIE - PALPARE

    Deformare toracic oc apexian

    Semn Harzer Freamt Puls periferic

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    AUSCULTAIE

    Zgomote I, II, III, IV Sufluri sistolice, diastolice, continuu -

    localizare, iradiere Raluri

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    INVESTIGAII PARACLINICE

    Radiofgrafia standard Electrocardiograma

    Fonocardiograma Ecocardiografia Cateterism

    Angiografia

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    ELECTROCARDIOGRAMA

    Frecvena Tulburri de ritm

    Axa electric Hipertrofii atriale, ventriculare Intervale PR, QRS, QT

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    MALADII CU SHUNT STG-DR

    Maladii potenial cianogene Inversarea shunt-ului Eisenmenger

    Hipertensiune pulmonar Afeciuni defecte septale(DSA,DSV,canal A-V)

    - persisten de canal arterial

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    Defect septal interatrial

    5-9% la nn 17-20% la adult Ostium primum 50%

    Ostium secundum Sinus venos Clinic

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    Canal atrio-ventricular

    2-6% Sindrom Down

    Asociere DSA, DSV, anomalii valvulare Clinic Radiologic

    ECG deviere axial stng

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    Persistena canalului arterial

    12-15% - 25% n asocieri La prematuri 45-80%

    Rubeola Istm aortic artera pulmonar stng 5-15 mm lungime, 6 mm grosime

    Clinic Radiologic, ECG, Eco